6. 6. Discussion and possible action regarding the

following opportunities for Plan Year 2017

beginning July 1, 2016 (For Possible Action):

6.1. New reduced cost CDHP national network

access for members living outside of

Nevada;

6.2. Utilizing existing Third Party Administrator

(HealthSCOPE Benefits), contract with a

telemedicine vendor for virtual visits.

(Mary Catherine Person, HSB)

Cost Containment Strategies

1

NATIONAL PROVIDER NETWORK For Members Outside Nevada

2

DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada

NETWORK DISRUPTION

Eligible Charges Analyzed ** $12,129,737

Incumbent * Aetna Cigna PPO

Total Charges In-Network: $10,982,659 $11,402,230 $11,803,184

Facility Charges In-Network: $7,563,206 $7,532,841 $7,897,755

Physician Charges In-Network: $3,419,454 $3,869,389 $3,905,428

% of Charges In-Network: 90.5% 94.0% 97.3%

3

*Incumbent Network ** Charges sampled represent 100% of facility & physician charges for ee’s outside NV from January – December 2015 Additional Utilization Review and Case Management fees may apply. Please consult your account manager.

DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada

DISCOUNTS & SAVINGSSavings are calculated by applying facility & physician discounts to the respective in-network dollars.

Incumbent * Aetna Cigna PPO

Facility Charges In-Network: $7,563,206 $7,532,841 $7,897,755

Facility Discount: 23.8% 43.4% 43.5%

Facility Savings: $1,798,404 $3,270,613 $3,439,317

Physician Charges In-Network: $3,419,454 $3,869,389 $3,905,428

Physician Discount: 38.6% 49.5% 44.9%

Physician Savings: $1,319,056 $1,916,089 $1,755,220

Facility & Physician Charges In-Network: $10,982,659 $11,402,230 $11,803,184

Facility & Physician Discount: 28.4% 45.5% 44.0%

Facility & Physician Savings: $3,117,459 $5,186,703 $5,194,537

4

*Incumbent Network

DISRUPTION ANALYSIS/SAVINGS Outs ide Nevada

ACCESS FEES & OVERALL SAVINGS

Employee Count 810

Months in Period (claims timeframe) 12

Incumbent * Aetna Cigna PPO

Fee PEPM $5.50 $12.50 $10.00

Fee Per Period $53,460.00 $121,500.00 $97,200.00

TOTAL OVERALL SAVINGS: $3,063,999 $5,065,203 $5,097,337

5

*Incumbent Network

TELEMEDICINE

6

EMERGENCY ROOM / URGENT CARE SUMMARY

46.9% of Overall ER/UC

Spending is considered

Non-Emergent per HSB

PEBP HSB Index

Emergency

RoomUgent Care Total

Emergency

RoomUgent Care Total

Number of Visits 4,556 7,412 11,968

Number of Admits 746 1 747

Visits Per Member* 0.16 0.25 0.41 0.17 0.24 0.41

Visits/1000 Members* 157 255 412 174 242 415

Average Paid Per Visit $1,897 $46 $751 $1,684 $74 $749

% of Visits w/ HSB ER Dx 51.5% 29.8% 38.1%

Total Paid $8,642,901 $342,993 $8,985,894

53.9%

31.6%

53.1%

46.1%

68.4%

46.9%

ER UC Total

% of ER/UC Paid

HSB Emergency Dx Non-Emergent Dx

51.5%

29.8%38.1%

48.5%

70.2%61.9%

ER UC Total

% of ER/UC Visits

HSB Emergency Dx Non-Emergent Dx

7

EMERGENCY VS NON -EMERGENCY VISIT BREAKDOWN

371

352

307

353

303 311349

307

362

315 311302

292

321

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Emergency Room by Day of Week

ER Non-Er

# Visits Total Paid Paid per Visit

PY15 3Q PY16 PY15 3Q PY16 PY15 3Q PY16

Emergent Visits

Emergency Room 2,189 2,346 $4,695,174 $4,660,963 $2,145 $1,987

Urgent Care 1,829 2,212 $68,262 $108,224 $37 $49

Overall 4,018 4,558 $4,763,436 $4,769,187 $1,186 $1,046

Non-Emergent Visits

Emergency Room 2,528 2,210 $4,315,199 $3,981,939 $1,707 $1,802

Urgent Care 5,756 5,200 $198,099 $234,769 $34 $45

Overall 8,284 7,410 $4,513,298 $4,216,708 $545 $569

284

404

304 306 294331

289

566

893830

786771

712642

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Urgent Care by Day of Week

ER Non-Er

Top 10 Non-Emergent Diagnoses

Diagnosis Description Total Paid

HEADACHE $203,631

UNSPECIFIED ABDOMINAL PAIN $112,402

ABDOMINAL PAIN, OTHER SPECIFIED SITE $79,672

SUICIDAL IDEATIONS $71,217

ABSCESS OF LUNG $65,271

FEVER, UNSPECIFIED $62,576

MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED $57,374

POSTPARTUM COAG DEFECTS, POSTPARTUM COND OR COMPLICATION $54,892

ALTERED MENTAL STATUS $53,817

RIGHT LOWER QUADRANT PAIN $51,822

8

9

Doctor On Demand is Telemedicine That Works

Top-Rated Patient Experience • 3x more 5-start reviews than competitors combined

Highest Clinical Standards • Board certified doctors – 100% dedicated to DOD

• NCQA, HITRUST and ATA Accredited

Comprehensive Support • Custom implementation and engagement marketing

• HealthSCOPE Benefits has existing contracts with Doctor on Demand to eliminate

unnecessary administrative burden

• Real-time eligibility checks and claims filing

Employer-Friendly Business Model • No start-up costs and No PEPM fees

10

• Doctor On Demand has received

multiple accreditations for

rigorous credentialing, quality

care, and industry-leading data

security

HIGHEST STANDARDS FOR QUALITY AND DATA SECURITY

11

1. Doctor On Demand quantitative research

(N=2400)

2. Updated 2/16/16

3. American Well, MDLIVE, and Teladoc.

More 5-star reviews

than all other

telemedicine

companies

combined2,3

3X

87%

Recommended

Doctor On

Demand

to a friend or

colleague1 Average Rating

2,416 Ratings

4.8

Average Rating

8,267 Ratings

4.6

#1 IN PATIENT SATISFACTION

12

Understand your needs

and goals for

telemedicine

Detailed project

management to ensure

seamless integration

with any health plan

Real-time eligibility

checks and claim filing

Based on quantitative

research about who is most

likely to use Doctor On

Demand and why

Leverages behavioral

economics-based playbook

to incentivize use

Continuous monitoring and

refinement of all marketing

programs and tactics

Customized

engagement plans for

each HR customer to

achieve awareness,

registration, and

utilization goals

Detailed employee

utilization reports

87% of our patients

have referred friends

and colleagues

Straightforward

Implementation

Best-in-Class

Engagement Intelligent Marketing

ENGAGING YOUR TELEMEDICINE SUCCESS

13

Total Cost Savings

14

TOTAL COST SAVINGS

• National Medical Network Change - $2 Million • Addition of Telemedicine – Approximately $500,000

Total = Estimated Savings of $2.5 Million